Many non-profit hospitals don't do enough to tell needy patients they may qualify for charity care programs, or how to apply for help, according to a report released today by The Access Project and Community Catalyst.

The report, Best Kept Secrets, examines whether non-profit hospitals are meeting the voluntary guidelines established by the American Hospital Association for billing and collections for uninsured and underinsured patients.

AHA guidelines call on hospitals to have clear, written policies to help patients determine if they qualify for charity care and to make these policies available to patients and the public.

Best Kept Secrets is based on a 2009 national survey of 99 randomly selected non-profit hospitals that was conducted by The Access Project. The survey found that while most hospitals mentioned their charity care programs on their Web sites or over the telephone, only 25% provided eligibility information. Less than half provided a charity care application form, and less than 1 in 10 hospitals listed discounts for income levels on their Web sites.

"This report illustrates that voluntary guidelines are ineffective," said Access Project director Mark Rukavina. "Given the state of our economy and the insecurity Americans feel regarding healthcare costs, hospital charity care is and will continue to be an important part of our healthcare safety net. Both federal and state governments must ensure that hospitals receiving tax breaks are also fulfilling their charitable obligations."

The federal healthcare reform law requires tax-exempt hospitals to establish and publicize financial assistance policies that clearly specify eligibility criteria. They are also banned from taking extraordinary collection actions before making a reasonable effort to determine if patients qualify for financial assistance.

Jessica Curtis, director of the Hospital Accountability Project at Community Catalyst, called the report "surprising and disappointing given that hospital billing and collection practices have been closely scrutinized over the last decade by Congress and many state governments."

"It will be important for the federal government to develop regulations that establish very clear standards for tax-exempt hospitals and then monitor hospital behavior to ensure that they comply with the new requirements," Curtis said.

Hospitals take their mission of caring for the uninsured and underinsured "very seriously," the AHA said in a statement repsonding to The Access Project's report.

"Today's report is out of sync with field practices and the health reform legislation, which we supported," AHA officials said in the statement. "The legislation includes provisions similar to AHA's voluntary guidelines. From conversations with our members, we know that there is a great deal of time and energy dedicated to helping the uninsured and that hospitals are constantly developing new and better ways to communicate with the uninsured and underinsured."

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